Scaramedic Posted May 23, 2006 Share Posted May 23, 2006 We would not have been able to intubate the pt (using an AS) What is an "AS"? a smaller combi-tube.Goes in easier, and is best used for all adults unless you have a really big guy. ?????????? Oh...you said intubate though. A combitube isn't intubation. But even still I don't understand. Why would you use this AS device if oral intubation was available to you? A combitube is a rescue device in the event of a failed intubation. Why would you go straight to that? I assume you can orally intubate since you said for some reason you would elect to go nasal (I assume intubation, unless it is some other device like this "AS" thing). Could you clarify please? Actually, that was how he described the AS airway thingimajig. The "Patten" airway was just a misspelling of patent. You also appeared to have been discussing intubation should he have required it. Then you go on to mention this mysterious "AS" device which is similar to a combitube. What does "AS" stand for, and do you have a link/pic of this product? You then said you would not have intubated this person (was this with or without this "AS" thing?) because of previous (and then unknown) esophageal surgury. And state you would have done a "nasal". Is esophageal surgery a contraindication for this "AS" device? I cannot believe I am agreeing with VS on anything, but I also want to know what this "AS" is. I have never heard of an AS Combitube. Pray tell. Peace, Marty :thumbleft: Link to comment Share on other sites More sharing options...
TZETAH Posted May 23, 2006 Author Share Posted May 23, 2006 Do you know what an "SA" is. In my frustration and of trying to help you guys understand this scenario, I transposed the letters. My bad....I am new coming into this website and haven't been in the field for a full year yet. I may have transposed a few letters when I am writing with the kids running around & the TV on, But I do know what I am doing in the field and thought that I could learn & sharpen my skill here. yes, I know the difference between supine, prone, trendelenburg, etc. Thank you and have a great day. :? Next scenario Please...... :arrow: Link to comment Share on other sites More sharing options...
hammerpcp Posted May 23, 2006 Share Posted May 23, 2006 Link to comment Share on other sites More sharing options...
TechMedic05 Posted May 23, 2006 Share Posted May 23, 2006 SA ...You mean Small Adult? Which is less of a guess than Adult Small, from AS? Link to comment Share on other sites More sharing options...
vs-eh? Posted May 23, 2006 Share Posted May 23, 2006 First of all this article http://www.ispub.com/ostia/index.php?xmlFi...ol5n2/combi.xml references a "Combitube SA". It does appear (I briefly skimmed it) that it is in fact for a smaller adult between 4'-5'5''. Although, it did later reference a range of 4'-6'...Potentially that may clear up something, though not much considering I still don't know why that would have been your first option if oral intubation is available... The comments I made regarding oral, nasal, combi etc. were in regards to Medic2588. He stated --"I agree, first off, board supine to better manage the airway. The fact that he can't breath supine alone is a sign that advanced airway maneuvers are necessary, in my opinion anyway. " That is when I stated that it probably would have been difficult (not that I would have known about the linement being out of whack without seeing the X-rays, it was just a comment) --I based this comment on the fact that in the ER they Tried to get a combi in before proceeding with a chest tube and they could not, had to go nasal. Once the X-RAYS were examined they showed me that he had surgery in the past and they said that his esophagus was not in line---Don't' ask me I am not an x-ray technician. I just saw what looked to me as a slight curve--trachea sounds better to me too. I don't work in a hospital and am not a nurse so I take what people tell me with face value. These were those comments... please see my edit on last pg for MOI. As to why prone, remember this is how we found pt upon arriving on scene not the way transported. We would not have been able to intubate the pt (using an AS) if things went bad anyway due to a previous neck surgery, sometime ago, because his esophagus is out of line. (Saw the x rays after arrival to hospital). Even though we didn't know this at the time, if he went unresponsive and we had trouble we would of gone for nasal (never my first choice). So what you are saying is that these events regarding combitubes or nasal intubation took place in the hospital? Your comments certainly suggest that these were YOUR thought processes regarding this patient should he require advanced airway maneuvers. And that YOU would have gone for a "nasal" (I still don't know if this means nasal intubation because you refer to this SA as intubation so...) because of this previous esophageal surgery for whatever reason. And I still don't understand why the ER would elect to go to a CT (was this after failed oral intubation?), then realize the patient had previous esophageal surgery, and go "oh?" and then do a nasal intubation? According to my references, previous esophageal surgery is not a contraindication for CT placement, regardless of why they were electing to place it. Most chest x-rays that I have seen does show the trachea (or do you mean esophagus, cause I don't know anymore) to have a "slight curve" and not perfectly verticaly straight. This would most certainly be the case if this patient had a tension pneumo, from the tracheal/mediastinal shift... Sorry, if it was your apparent frustration that lead to you "misleading" people with answers and transposed letters/words... Are you an EMT-B or EMT-P? Link to comment Share on other sites More sharing options...
TZETAH Posted May 23, 2006 Author Share Posted May 23, 2006 vs-eh? Yes, you are getting it, intubating was done in the hospital not by our crew. Thank You!!! the X-ray was of the neck, looked like there had been a plate attached to the back of neck from the previous surgery, don't quote me regarding the plate--don't even want to go there for goodness sakes!! I did not see the Xrays from the chest area. Why are you so hung up on whether I am an EMT-B or P??? Would it really make you happy (relieved) if I said "B" vs "P"?? Is it because of the whole compartment thing that was discussed earlier, I forget by who!? For the record I looked that up also. And found that if it was a crush compartment Syndrome that Sodium Bi-Carb would be the First drug to administer before a pt is extricated. Take the 1987 Amtrak Derailment for example-- Middle aged women pinned for 12 hrs, conscious, alert & oriented X4 throughout stable vitals. Within 15 min of extrication, pt went into sudden V-Fib arrest & died despite rapid ACLS & transport to an area trauma center. or perhaps some could use insulin which would transport dextrose through the cell membranes and pulls potassium with it. or Albuterol lowers serum potassium case by driving it back into cells What do you think??? Off the subject, but not really since some else had brought it up in this forum and was told no don't think so. Just a thought.. :roll: Do we have a new scenario yet? Link to comment Share on other sites More sharing options...
Dustdevil Posted May 23, 2006 Share Posted May 23, 2006 Why are you so hung up on whether I am an EMT-B or P??? Would it really make you happy (relieved) if I said "B" vs "P"?? Why are you so hung up on dodging the question? And every other question we have asked so far. [stream:52e6609944]http://www.destgulch.com/movies/luke/luke18.wav[/stream:52e6609944] Link to comment Share on other sites More sharing options...
vs-eh? Posted May 23, 2006 Share Posted May 23, 2006 vs-eh? Yes, you are getting it, intubating was done in the hospital not by our crew. Thank You!!! This is quite possibly the greatest/most confusing/unbelievable gongshow of a thread that has ever been seen on EMT CITY. TZETAH, you seem to be severely misusing words, transposing words/letters, and merging events that happened on scene and at the hospital, but making it seem that it was you that was thinking/doing them! As to why prone, remember this is how we found pt upon arriving on scene not the way transported. We would not have been able to intubate the pt (using an AS) if things went bad anyway due to a previous neck surgery, sometime ago, because his esophagus is out of line. (Saw the x rays after arrival to hospital). Even though we didn't know this at the time, if he went unresponsive and we had trouble we would of gone for nasal (never my first choice). Tell me that you don't see that with what you wrote, it would imply that these would have been your thought processes/actions. In fact they were not. In fact these were the thoughts/actions of the ER DOCTOR or ANESTHETIST AT THE HOSPITAL! And I still don't understand why things were done they way they were done there either! Please go back, and re-read the thread and hopefully answer any remaining questions. I think I covered what this "AS" errr, "SA" device is now... No need to pull information off the net regarding treatments for hyperkalemia... Lemme hypothesize on what happened on this scene... YOU were part of an EMT-B crew that transported this patient to the hospital while PRONE and trying to VENTILATE him in this position, with these injuries. The patient had a tension/hemo pneumo and probably barely escaped death. YOU got in shite for it, and are now asking for others opinions to try and justify YOUR actions. Am I getting it? EDIT - I don't need your civil war It feeds the rich while it buries the poor Your power hungry sellin' soldiers In a human grocery store Ain't that fresh I don't need your civil war That relates to Dust's entry... Link to comment Share on other sites More sharing options...
Scaramedic Posted May 23, 2006 Share Posted May 23, 2006 Is it because of the whole compartment thing that was discussed earlier, I forget by who!? For the record I looked that up also. And found that if it was a crush compartment Syndrome that Sodium Bi-Carb would be the First drug to administer before a pt is extricated......or perhaps some could use insulin which would transport dextrose through the cell membranes and pulls potassium with it. .....or Albuterol lowers serum potassium case by driving it back into cells Ummm it's great to know you can use cut & paste, but do you really understand anything you are saying? I'm thinking you are a brand new volunteer who ran on a really "neat" call and you want to talk about it. That's great, I love to hear people getting excited about calls. Just do not pretend to be something you are not by using Google to quote medical knowledge. If you want to be in EMS Internet search engines are not the way to go, people in the business can see through this BS in a New York minute. Take the appropriate classes, educate yourself, and most of all ask questions instead of making statements you do not understand. Peace, Marty :thumbleft: P.S. "Shaking the bush boss, shaking the bush" Also relates to Dust's post. Link to comment Share on other sites More sharing options...
TZETAH Posted May 24, 2006 Author Share Posted May 24, 2006 Excuse me, Gentlemen, But I have taken the classes necessary to perform my job as an EMT. I am not here to gloat or mislead anyone, but to learn more of what I do not already know. I have been on a lot of runs and love feed back on what I could have done different or even better in some cases because there is always room for improvement. I think that you guys just might be the type that can't let a new-by learn anything because perhaps they might just catch on quicker that you all did. I came on here to summit a scenario, if it was to confusing (obviously) than for that I apologize, but to continue to pick apart and a brake down someones self worth just because you can't grasp the text is not right. You know that I am EMT-B that's why I put the scenario here. I am in no way trying to be something I am not, I told Dustdevil long before I put this scenario up That I was an EMT-B and he basically told me exactly what he thought about EMT-B's, do you think that I wanted to tell anyone else. I just thought that this would be a place where I could learn new techniques and sharpen my skills, mentally. Sorry, Have a great day!!!! Link to comment Share on other sites More sharing options...
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